Social and Biological Determinants of Pregnancy-Related Mortality and Morbidity in a Rural, Underserved Population

Cases of severe maternal morbidity (SMM) and pregnancy-related mortality (PRM) are increasing in the US. Research concerning SMM and PRM has neglected women in Central Appalachia; a largely rural, health-disparate population. The aims of this study are two-fold: (1) Examine patient-level and place-based predictors of SMM/PRM via hierarchical logistic regression modeling, and (2) Elucidate Appalachian healthcare patients’ and providers’ experiences with SMM/PRM, perceptions of contributing factors, and insights on points of intervention. This study uses a mixed methods approach guided by the WHO’s conceptual framework for action on social determinants of health to identify determinants of SMM and PRM among Appalachian women. Aim 1 involved hierarchical logistic regression modeling to assess patient-level and regional predictors of SMM and PRM using the MarketScan Research Database. Aim 2 involved 30 qualitative interviews with Appalachian participants: 10 patients with histories of SMM, 10 providers, and 10 emergency medical technicians (EMTs). Quantitative results demonstrate patient-level chronic diseases and regional measures of economic security as predictive of SMM. Qualitative results echoed the effect of regional economic hardship on maternal health. Participants expressed a link between changes in the socioeconomic landscapes of their communities and more proximal determinants of maternal health, including patient nutritional status, chronic disease burden, and underutilization of healthcare. Patients with histories of SMM pointed to geographic constraints in healthcare resources and biases within healthcare surrounding patients’ reflections of class. Participants identified many points of intervention, including collaborations between EMS and obstetric care providers, partnerships with local school systems to introduce comprehensive health education curricula, and expansion of community paramedics programs. Findings warrant further investigation into how regional economic policy may influence maternal health outcomes among women living in economically insecure regions. Findings highlight the need for medical stewardship. Additionally, results reflect how current care-delivery models for medically and socially complex patients may be inadequate for women in rural communities

A Review of Nebraska Public School Active Shooter/Armed Intruder Preparedness Requirements Compared to Other States

Approximately 17% of mass shootings which occurred between 2000 and 2013 took place in the public school K-12 setting. The incidence of school shootings is on the rise, with a particularly concerning increase in annual incidents beginning around 2010. A review of legal requirements for public school active shooter preparedness in FEMA Region VII, which includes the states Nebraska, Iowa, Kansas, and Missouri, was conducted. While Iowa clearly requires an emergency operations plan including provisions for the active shooter scenario, Nebraska and Kansas do not clearly require such provisions in school emergency operations plans, and Missouri does not appear to require any kind of written emergency operations plan. Each State’s Department of Education website was reviewed to determine what resources, if any, were provided to educators for emergency preparedness planning in general and for the specific scenario of an active shooter, regardless of state legal requirements for preparedness. All State Departments of Education list emergency preparedness planning resources, but not all states list resources specifically for the active shooter scenario, and where there are active shooter specific resources available, these resources are not specific to the school setting. It is concluded that while all states in FEMA Region VII have room for growth surrounding legal active shooter emergency preparedness requirements in public schools, some states have more room for growth than others, and Missouri has the most room for growth

Studies towards a total synthesis of manzamine A

Manzamine A has been isolated from various Okinawa Sponges of the genus Haliclona and was first characterised by Higa and co-workers in 1986. The unusual and synthetically challenging structure consists of a pentacyclic core containing an array of 5-, 6-, 8-, and 13-membered rings with a pendant -carboline unit. The complex structure of manzamine A combined with its biological activities has made it a highly attractive synthetic target. The synthetic endeavors in the Clark group to develop a novel approach towards the total synthesis of manzamine A (i) with the main focus on the synthesis of the ABC ring fragment as advanced intermediates will be disclosed. In the first synthetic approach towards the total synthesis of manzamnine A (i), bicyclic enone iii was constructed from amine ii and served as a model system to validate the proposed intermolecular Diels-Alder reaction. Despite several attempts utilising various dienes, the Diels-Alder adduct was not obtained and an alternative bicyclic system was investigated. After accomplishing the synthesis of the simple AB fragment v from propargylamine (iv), the Diels- Alder reaction was yet again investigated. Due to the failure of the Diels-Alder reaction, this route towards the total synthesis of manzamine A (i) was abandoned. The second approach introduces the conjugate addition reaction towards the total synthesis of manzamine A (i). Instead of the Diels-Alder approach, 1,4 addition to enone v was explored. Initial attempts to perform the 1,4-addition reaction and subsequent aldol condensation reaction afforded the dehydrated aldol condensation products vii via silyl enol ether vi. Additional investigations to prevent the dehydration reaction taking place proved unsuccessful. Thereafter, various methods for the introduction of a substituent in the position to the ketone were investigated. These included alkylation using chloromethyl phenylsulfide, halogenation using NBS or NCS, Rubottom oxidation using DMDO, direct amination using manganese(V) complexes, azidation using sodium azide and CAN as well as aziridination using PhI=NTs. A number of adducts viii-x were succesfully prepared. Finally, the last part of the thesis describes the efforts towards the synthesis of a model system resembling the CD ring-system. The macrocyles xiii and xiv were easily synthesised from dienes xi and xii, although the RCM of diene xi gave rise to isolation problems

The professional activities of teachers in the Stockton Unified School District, 1956 to 1959

Statement of the problem: The problem had two parts. The first of these was to ascertain and record the types of professional activities of the teachers and the approximate time spent on these activities according to the teachers\u27 years of service in the Stockton Unified School District. The second was to analyze the resultant data to determine if any significant patterns of performance existed

Descriptive and Applied Military History – debating the utility of military history in Danish officer education

In the 1970s Danish debates on military history revealed a bifurcated understanding of military history between descriptive and applied military history. Descriptive military history was the study of military history done by academic historians, and applied military his- tory was done by and taught to officers. The divide between descriptive and applied was rooted in the professionalization of history and officer education; it was constructed in order to accommodate the criticism that military history used in officer education did not live up to aca- demic standards. By taking the Danish debates in the 1970s as a point of departure, this article introduces some fundamental challenges regard- ing the use of military history in officer education. Inspired by the Ger- man historian Reinhart Koselleck, the article argues that developments within academic history since the 1970s might have alleviated the con- flict between academic military history and the military history used in officer education. Certainly, these new developments have opened up new approaches to military history

Executive Summary: Evaluation of the MacArthur Foundation's Human Rights and International Justice Grantmaking in Nigeria 2000-2012

The MacArthur Foundation commissioned Itad to conduct an evaluation of the Foundation's Human Rights and International Justice (HRIJ) grant?making program in Nigeria between 2000 and 2012. During this period, the Foundation supported 102 HRIJ projects with an end?date in 2000 or later, for a total grant amount of US$23,945,010. The projects broadly fell within the following thematic categories:- Accountability of democratic institutions, including the police- Justice: legal and judicial reform, including international justice standards - Protection and promotion of human rightsThe evaluation was commissioned to seek answers to the following questions: - Approach and strategy: o What has changed in the wider Nigerian HRIJ landscape in Nigeria since 2000? o What was the Foundation's HRIJ grantmaking strategy in Nigeria over this time? o How has the Foundation responded to change in the wider environment? o How has the implementation of grants contributed to strategic aims? - Impact: o What have been the main results of the Foundation's investments? o What was the Foundation's primary contribution to Nigeria HRIJ issues? o What lessons can be drawn for future HRIJ grantmaking in Nigeria